Mammography :: Mammograms for women in their 40s should be based on individual cancer risks

Researchers advise clinicians to discuss the benefits and harms of screening with the patient, as well as each woman’s individual cancer risk and preference about screening.

The organization based its recommendations, published in the April 3 issue of Annals of Internal Medicine, on a rigorous review of evidence showing there is variation in the benefits and harms associated with mammography among women in their 40s.

The American College of Physicians is the leading professional organization for internal medicine specialists, with a membership of 120,000.

?There are important benefits to screening mammography, but we believe the decision to be screened should be based on an informed conversation between a patient and her physician,? said health policy expert Douglas K. Owens, MD, MS, a researcher with the Veterans Affairs Palo Alto Health Care System and a professor of medicine at the Stanford University School of Medicine, who chaired the committee that developed the guidelines. ?In our view, the evidence doesn?t support a blanket recommendation for women in this age group.?

Breast cancer is the second-leading cause of cancer related death among women in the United States; according to the American Cancer Society, 25 percent of all diagnosed cases are among women younger than age 50. Among these younger women, the risk of breast cancer varies greatly?from less than 1 percent for a 40-year-old woman with no risk factors to 6 percent for a 49-year-old woman with multiple risk factors, which include family history of breast cancer, older age at the birth of her first child and younger age at the onset of menstruation.

?We still think many women will choose to get mammography, and we?re supportive of that,? said Owens, who developed the guidelines in collaboration with Amir Qaseem, MD, PhD, MHA, and Vincenza Snow, MD, of the American College of Physicians; and colleagues from Drexel University College of Medicine, Beth Israel Deaconess Medical Center, Hines Veterans Affairs Hospital and Northwestern University, among others. ?The most important thing is that women be well-informed about the decision they?re making,? Owens added.

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